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Behavioral Health Services

  1. Please provide some guidance on how E&M codes are used for behavioral health issues?

    Answer:
    For E&M visits relative to behavioral health (e.g., drug addiction and/or rehabilitation), the need for a physical examination would only be supported by specific physical complaints presented by the patient on that date of service. The routine performance of a full ROS and comprehensive examination would, in most cases, be considered medically unnecessary. Documentation for the encounter should reflect appropriate counseling and perhaps coordination of care, and the medical record should reflect a summary of the counseling issues and the specific time face-to-face spent by the provider for the session. The assessment and plan would be expected to include an assessment of the patient’s progress and plans going forward. Since >50% of the visit is likely to represent counseling, the visit may be coded based on actual time spent face-to-face with the patient (which must be documented) at the coding level that correlates to the time spent. Updated 6/9/2017
     
  2. Can LCSWs use and bill for E&M codes such as 99212 or 99213?

    Answer:
    The elements of E&M services (history, examination and MDM) are not within the scope of service for LCSWs and these services may not be billed by these providers at any level. Updated 6/9/2017

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